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Measles

Rubeola

Measles, also known as rubeola, is one of the most contagious infectious diseases. It is a viral infection commonly affecting the pediatric population. The disease can be prevented by receiving vaccination against it.


Presentation

Preliminary signs and symptoms of measles begin to show effect after the 8 – 12 days of exposure to virus. The disease begins by development of rash which usually occurs 3 – 5 days after the individuals complain of feeling sick. The rash usually is first spotted on the head which then gradually spreads to other parts of the body. The rash is flat in appearance, red in color and is solid.

In addition to rash, the viral infection also produces other signs and symptoms which include fever, cough and cold, development of bloodshot eyes and conjunctivitis, sore throat, running nose, muscular pain, appearance of tiny white spots inside the mouth known as Koplik’s spots. Individuals with measles also develop sensitivity towards light [6].

Cervical Lymphadenopathy
  • The child presented with high fever, cough, cervical lymphadenopathy, and maculopapular rash followed by vesicular skin rash. The child was not immunized against measles and chickenpox.[ncbi.nlm.nih.gov]
Fever
  • When the rash appears, a person’s fever may spike to more than 104 Fahrenheit. After a few days, the fever subsides and the rash fades.[web.archive.org]
  • . -- Travelers with fever and other symptoms of measles should limit their contact with others as much as possible, to prevent the potential spread of the disease. -- Clinicians seeing a patient with fever and other symptoms of measles should ask about[medicalnewstoday.com]
  • Treat fever with acetaminophen (Tylenol ) or ibuprofen. Encourage the child to drink fluid and to rest. Use a cool-mist vaporizer to reduce coughing.[skinsight.com]
  • There was a statistically significant decrease in the duration of diarrhoea, pneumonia, hospital stay and fever in individual studies.[dx.doi.org]
  • Bacterial superinfection is suggested by pertinent focal signs or a relapse of fever, leukocytosis, or prostration.[web.archive.org]
High Fever
  • Measles typically begins with high fever, cough, runny nose (coryza), and red, watery eyes ( conjunctivitis ). Measles Rash Skin of a patient after 3 days of measles infection.[web.archive.org]
  • The child presented with high fever, cough, cervical lymphadenopathy, and maculopapular rash followed by vesicular skin rash. The child was not immunized against measles and chickenpox.[ncbi.nlm.nih.gov]
  • Measles is a highly contagious infectious disease characterised by a high fever, a rash and generally feeling unwell. The most severe cases can be fatal.[web.archive.org]
  • Other symptoms of measles include: Sore throat High fever Muscle pain Sensitivity to light Cleveland Clinic News & More Cleveland Clinic News & More[my.clevelandclinic.org]
Malaise
  • Measles is one of the most highly communicable infectious illnesses caused by an RNA paramyxovirus, with a morbidity and mortality underestimated by the general population. prodromal stage is characterised by the onset of fever, malaise, coryza, conjunctivitis[gpnotebook.co.uk]
  • There are three distinct phases: 1) incubation period; 2) prodromal phase characterized by fever, malaise, conjunctivitis, and upper respiratory symptoms such as cough, nasal discharge, and sneezing which persists for 3 to 4 days; and 3) exanthem which[aocd.org]
  • Initial temperature is usually high, Koplik spots and malaise are absent, and defervescence and rash occur simultaneously. Mortality is about 2/1000 in the US but is much higher in the developing world.[merckmanuals.com]
Hodgkin's Disease
  • ’s disease or leukaemia having an immune deficiency with extremely low levels of antibodies (hypogammaglobulinaemia, multiple myeloma or chronic lymphoblastic leukaemia).[betterhealth.vic.gov.au]
Infectious Mononucleosis
  • Differential diagnosis includes rubella, scarlet fever, drug rashes (eg, resulting from phenobarbital or sulfonamides), serum sickness, roseola infantum, infectious mononucleosis, erythema infectiosum (see Erythema Infectiosum ), and echovirus and coxsackievirus[web.archive.org]
  • The rash of rubeola must be differentiated from that of: Rubella Roseola infantum (human herpesvirus 6) Infections resulting from: * echovirus * coxsackievirus * adenovirus Infectious mononucleosis Toxoplasmosis Meningococcemia Scarlet fever Rickettsial[slideshare.net]
Cough
  • Treatments Your Physician May Prescribe There are no medications to cure measles, but the doctor can recommend ways to reduce symptoms such as fever, cough, or itching.[skinsight.com]
  • It is spread through the air by coughing and sneezing and is highly contagious. People with measles can spread the virus to others before they show symptoms.[katu.com]
  • Transmission is typically by large respiratory droplets that are discharged by cough and briefly remain airborne for a short distance.[web.archive.org]
  • The main symptoms are fever, rash, cough, running nose and eye infection, appearing after an incubation period of 10 to 12 days. Complications are possible, including pulmonary infection, brain infection and secondary bacterial infections.[ecdc.europa.eu]
  • The measles virus lives in the nose and throat mucus of an infected person, and can spread to others through coughing and sneezing.[blogs.cdc.gov]
Common Cold
  • He also developed a common cold 10 days before the vision loss. Ultrasonography showed an exudative retinal detachment 1 day after the onset of the visual reduction; however, his fundi appeared normal 4 days later.[ncbi.nlm.nih.gov]
  • Measles usually begins like a common cold after a seven to fourteen day incubation period, with sinus congestion, a runny nose, a cough, and red, irritated eyes.[rarediseases.org]
  • Symptoms of measles The initial symptoms of measles are much like a common cold of flu. There is high fever, red and runny eyes and nose and a characteristic rash. There are greyish white spots in the mouth and throat.[news-medical.net]
  • It is marked by symptoms that are similar to a common cold, as well as a characteristic red rash. Less than two decades ago, measles was almost wiped out in the United States, thanks to vaccines.[livescience.com]
  • Treatment and Prevention Like the common cold, measles is a viral infection that the body will fight off and will go away with time.[medbroadcast.com]
Dry Cough
  • cough, and red-brown spotty rash (see below).[web.archive.org]
  • Clinical images CMAJ March 03, 2009 180 (5) 583; DOI: A 30-year-old man presented with a 6-day history of fever, conjunctivitis, rhinitis, dry cough and dyspnea.[doi.org]
  • Measles symptoms: Fever General discomfort, illness or lack of wellbeing Runny nose Dry cough Sore and red eyes (conjunctivitis) Red and bluish spots inside the mouth Red and blotchy skin rash on the face and hairline, which spreads to the body Source[abc.net.au]
  • Signs and symptoms of measles typically include: Fever Dry cough Runny nose Sore throat Inflamed eyes (conjunctivitis) Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek — also called[mayoclinic.org]
  • The patient may also have a dry cough. Almost all cases require treatment by a doctor. To test for measles, a doctor will simply examine the patient for telltale symptoms, such as spots inside of the mouth and the skin rash.[livescience.com]
Pharyngitis
  • By the second day of the rash, there is no detection of the virus in pharyngeal secretions. The rash begins to spread down the neck, trunk, and extremities. By day three, the whole body is covered.[aocd.org]
  • A general inflammatory reaction of the buccal and pharyngeal mucosa extends into the lymphoid tissue and the tracheobronchial mucous membrane. 19. Pathogenesis (cont.)[slideshare.net]
  • Occurence of numerous large giant cells in the tonsils and pharyngeal mucosa in the prodormal stage of measles. Arch. Pathol. 1931; 11 :864–874. [ Google Scholar ] 39. Finkeldey W.[ncbi.nlm.nih.gov]
Nasal Discharge
  • There are three distinct phases: 1) incubation period; 2) prodromal phase characterized by fever, malaise, conjunctivitis, and upper respiratory symptoms such as cough, nasal discharge, and sneezing which persists for 3 to 4 days; and 3) exanthem which[aocd.org]
  • discharge/mucous of an infected person.[nvic.org]
  • After an incubation period of about 10 days, the patient develops fever, redness and watering of the eyes, profuse nasal discharge, and congestion of the mucous membrane s of the nose and throat—symptoms often mistaken for those of a severe cold.[britannica.com]
Diarrhea
  • Common Complications Common measles complications include ear infections and diarrhea. Ear infections occur in about one out of every 10 children with measles and can result in permanent hearing loss.[web.archive.org]
  • There was no difference in the incidence of conjunctivitis (OR 0.39; 95% CI 0.15 to 1.0), diarrhea (OR 0.53; 95% CI 0.23 to 1.22) or croup (OR 0.16; 95% CI 0.01 to 4.06). No major adverse effects attributable to antibiotics were reported.[ncbi.nlm.nih.gov]
  • Some people with measles can also get an ear infection, diarrhea, serious lung infection, or, even more rarely, inflammation of the brain ( encephalitis ).[medicalnewstoday.com]
  • Complications from measles more commonly occur in children aged younger than 5 and adults older than 20 and include ear infections and diarrhea.[skinsight.com]
  • However, the majority of measles patients will feel extremely sick for approximately one week, and up to 30% will suffer some sort of complication to the disease, ranging from diarrhea, ear infections, or pneumonia to seizures or hearing loss as a result[historyofvaccines.org]
Vomiting
  • Symptoms of RS include persistent or recurrent vomiting, listlessness, personality changes such as irritability or combativeness, disorientation or confusion, delirium, convulsions, and loss of consciousness.[ninds.nih.gov]
  • Taking too much at one time — over 200,000 micrograms — can cause nausea, vomiting, vertigo or blurry vision. More than 10,000 micrograms per day can cause long-term damage, such as bone thinning and liver damage.[nbcnews.com]
  • […] measles-induced encephalitis Measles symptoms Encephalitis symptoms Fever Fever Morbilliform rash Headache Cough Altered level of consciousness Coryza Behavioral disturbances Conjunctivitis Disorientation Koplik spots Speech disturbances Seizures Nausea Vomiting[dx.doi.org]
Nausea
  • Slow start My illness started about a month ago with a slight feeling of nausea, and a mild, intermittent fever. Over a weekend I developed a deep, convulsive, painful cough, and a burning sore throat.[news.bbc.co.uk]
  • Taking too much at one time — over 200,000 micrograms — can cause nausea, vomiting, vertigo or blurry vision. More than 10,000 micrograms per day can cause long-term damage, such as bone thinning and liver damage.[nbcnews.com]
  • […] of measles-induced encephalitis Measles symptoms Encephalitis symptoms Fever Fever Morbilliform rash Headache Cough Altered level of consciousness Coryza Behavioral disturbances Conjunctivitis Disorientation Koplik spots Speech disturbances Seizures Nausea[dx.doi.org]
Abdominal Pain
  • Atypical measles syndrome may begin abruptly, with high fever, prostration, headache, abdominal pain, and cough. The rash may appear 1 to 2 days later, often beginning on the extremities, and may be maculopapular, vesicular, urticarial, or purpuric.[web.archive.org]
  • On August 23, the officer had wheezing, abdominal pain, and sweating, followed by rash on August 27. A serum sample obtained August 30 was positive for measles IgM antibodies.[cdc.gov]
Koplik Spot
  • Español: Signos y síntomas del sarampión Koplik Spots Mouth of a patient with Koplik spots, an early sign of measles infection. The symptoms of measles generally appear about seven to 14 days after a person is infected.[web.archive.org]
  • Koplik spots are highly characteristic of the prodromal phase of measles and can often be identified before the onset of the rash.[doi.org]
  • Especially the exact onset of the Koplik spots should be further explored in detail. In future, a larger population should be observed and clinical diagnostics for measles defined. Copyright 2012 S. Karger AG, Basel.[ncbi.nlm.nih.gov]
  • It is characterized by fever, cough, coryza, conjunctivitis, an enanthem (Koplik spots) on the oral mucosa, and a maculopapular rash that spreads cephalocaudally. Diagnosis is usually clinical. Treatment is supportive.[merckmanuals.com]
Tachycardia
  • Neonatal presentation of ventricular tachycardia and a Reye-like syndrome episode associated with disturbed mitochondrial energy metabolism. BMC Pediatr 2002; 2: 12 PubMed CrossRef Google Scholar 20. Marsden D, Nyhan WL, Barshop BA.[doi.org]
Red Eye
  • Around 10 days after you get the measles infection, the following symptoms begin to appear: cold-like symptoms, such as runny nose, watery eyes, swollen eyelids and sneezing, red eyes and sensitivity to light, a mild to severe temperature, which may peak[web.archive.org]
  • Measles symptoms start with a fever, cough, runny nose and red eyes followed by a red rash that usually begins at the head and spreads to the rest of the body.[katu.com]
  • Measles starts with fever, runny nose, cough, red eyes, and sore throat. It’s followed by a rash that spreads over the body. Measles is highly contagious and spreads through coughing and sneezing.[cdc.gov]
  • Initial symptoms The initial symptoms of measles can include: a runny or blocked nose sneezing watery eyes swollen eyelids sore, red eyes that may be sensitive to light a high temperature (fever), which may reach around 40C (104F) small greyish-white[nhs.uk]
  • After two to four days of listlessness, the rash, cough, stuffiness and red eyes (conjunctivitis) abruptly improve. If no complications have set in, measles has run its course by the tenth day.[rarediseases.org]
Photophobia
  • During peak disease severity, a patient's temperature may exceed 40 C, with periorbital edema, conjunctivitis, photophobia, a hacking cough, extensive rash, prostration, and mild itching.[web.archive.org]
  • […] head and spreads to other areas, moving down the body May appear as flat, discolored areas ( macules ) and solid, red, raised areas ( papules ) that later join together Itches Other symptoms may include: Bloodshot eyes Cough Fever Light sensitivity ( photophobia[nlm.nih.gov]
  • During peak disease severity, a patient’s temperature may exceed 40 C, with periorbital edema, conjunctivitis, photophobia, a hacking cough, extensive rash, prostration, and mild itching.[merckmanuals.com]
Eruptions
  • At this period the eruption on the skin has not made its appearance. In the majority of cases there is no suspicion of any exanthema. In a few cases there is an indistinct spotting around the lips and alae nasi, but no eruption.[doi.org]
  • Abstract Measles is a highly contagious viral infection associated with clinical symptoms such as fever, cough, conjunctivitis, coryza, eruption and increased serum immunoglobulin M (IgM) antibodies.[ncbi.nlm.nih.gov]
  • […] mea·sles \ ˈmē-zəlz \ 1 a : an acute contagious disease that is caused by a morbillivirus (species Measles virus ) and is marked especially by an eruption of distinct red circular spots — called also rubeola b : any of various eruptive diseases (such[merriam-webster.com]
  • After several days, a rash erupts, usually on the face and upper neck. Over about 3 days, the rash spreads, eventually reaching the hands and feet. The rash lasts for 5 to 6 days, and then fades.[who.int]
  • Constitutional symptoms and signs parallel the severity of the eruption and the epidemic.[web.archive.org]
Exanthema
  • Author information 1 Service d'Accueil des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 48 boulevard Sérurier, Paris Cedex 19, France. lauren.pull@rdb.aphp.fr Abstract Febrile exanthema is a common symptom in returning[ncbi.nlm.nih.gov]
  • KEYWORDS: dermatopathology; exanthema; follicular necrotic keratinocytes; measles; syncytial-type multinucleated epithelial cell[ncbi.nlm.nih.gov]
  • In the majority of cases there is no suspicion of any exanthema. In a few cases there is an indistinct spotting around the lips and alae nasi, but no eruption.[doi.org]
  • Classic Paper The diagnosis of the invasion of measles from a study of the exanthema as it appears on the buccal mucous membrane † Corresponding Author University Department of Medical Microbiology and Alder Hey Children's Hospital, Liverpool University[doi.org]
Petechiae
  • Petechiae or ecchymoses may occur with severe rashes. During peak disease severity, a patient's temperature may exceed 40 C, with periorbital edema, conjunctivitis, photophobia, a hacking cough, extensive rash, prostration, and mild itching.[web.archive.org]
  • Petechiae or ecchymoses may occur with severe rashes. During peak disease severity, a patient’s temperature may exceed 40 C, with periorbital edema, conjunctivitis, photophobia, a hacking cough, extensive rash, prostration, and mild itching.[merckmanuals.com]
Headache
  • The patient went to her medical provider on January 30 after 3 days of headache and fever and 2 days of papular rash. The rash began on her neck and spread to her abdomen, legs, and back. Two days later she developed coryza and cough.[ncbi.nlm.nih.gov]
  • Encephalitis occurs in 1/1000 to 2000 cases, usually 2 days to 2 wk after onset of the rash, often beginning with recrudescence of high fever, headache, seizures, and coma.[web.archive.org]
  • Encephalitis pathogenesis Encephalitis is an inflammation of the brain parenchyma and typically manifests with a triad of symptoms comprising fever, headache and altered level of consciousness.[dx.doi.org]
Febrile Convulsions
  • The doctor must make sure there are no further complications such as: Fitting associated with the high fever ( febrile convulsions/febrile fits ) Pneumonia (due to secondary bacterial infection) Inflammation of the middle ear (otitis media) Inflammation[netdoctor.co.uk]
  • It's also common for babies and children with measles to have a febrile convulsion or seizure (NHS 2015b) . If this happens to your baby, and he hasn't had a convulsion before, call an ambulance, or take him to A&E (NHS 2016) .[babycentre.co.uk]

Workup

Measles is diagnosed by careful examination of the rash that develops on the body. If along with the rash, there is appearance of bluish–white spot with a bright red background inside the cheek then the diagnosis is confirmed [7]. In many cases, a complete blood count is conducted which would reveal elevated levels of antibodies in individuals with measles.

X-Ray Abnormal
  • Pneumonia and hilar adenopathy are common and may be prolonged; chest x-ray abnormalities may persist for weeks to months. Symptomatic hypoxemia may occur.[web.archive.org]
Chest X-Ray Abnormal
  • Pneumonia and hilar adenopathy are common and may be prolonged; chest x-ray abnormalities may persist for weeks to months. Symptomatic hypoxemia may occur.[web.archive.org]

Treatment

There is no specific regime for treating measles. However, certain measures can be adopted to manage the symptoms of the disease. The following methods can be employed to effectively control the condition:

Vaccination: Measles vaccination can also be administered to individuals who have already contracted the disease condition. Individuals who have been exposed to the measles virus can be given the vaccination within 72 hours. In case, the illness still develops the symptoms are milder and of short duration [8].

Antibody injection: Pregnant women or infants who have been exposed to the measles virus are given the immune serum globulin injection. This antibody may even prevent the development of measles or can even reduce the degree of severity of symptoms.

Medications: Medications can be given to reduce fever and other associated symptoms of measles. In addition, antibiotics also form a part of the management if secondary infections co-exist.

Vitamin A: Vitamin A supplements are given to individuals with poor levels of this vitamin. Usually doses of 200,000 IU are given for 2 days.

Prognosis

Prognosis of the disease is usually favorable if treatment is initiated on time. However, in individuals who present with significant complications, then for such cases prognosis of the condition is poor requiring rigorous treatment regime.

Etiology

Children infected with the virus can spread the infection to other individuals as well. The virus that is known to cause measles is known measles virus, a paramyxovirus that belongs to the genus Morbillivirus. This virus can adversely affect the immune system, respiratory tract and the skin of the individuals. It is an airborne disease and can easily spread when the infected person either talks, coughs or sneezes. The infected particles can stay active and affect other persons who come in contact with it [2].

Epidemiology

Prior to the introduction of the measles virus vaccine, the disease affected about 90% children below the age of 5 years across the globe [3].The incidence of measles though decreased after the introduction of the vaccine, but considerable number of cases were still reported worldwide. In the year 2000, measles was reported to be the 5th most common cause of death amongst children below 5 years. In 2003, the disease caused about 31 – 39.9 million illnesses across the globe with about 733,000 – 777,000 deaths [4].

Sex distribution
Age distribution

Pathophysiology

The measles virus primarily attacks the respiratory system following the immune system. It is a highly contagious disease and the incidence peaks during the winter season. The infection spreads by coming in contact with infected droplets of the individual with measles. When the affected individual talks or sneezes, the droplets can stay in the active state for about 2 hours [5]. Once the virus gains entry into the human system, then after about 2 – 4 days it affects the lymphatic tissues. The virus then spreads to other parts of the body through the lymph nodes.

Prevention

It is necessary to take preventive steps to protect vulnerable individuals from measles. If someone in family has developed measles, the following steps can be taken to prevent the spread of the disease [9]:

Isolation: The infected person should be kept in isolation to prevent the spread of the virus. Non-immunized individual should not be in any way allowed to interact with affected individuals.

Vaccination: This is one of the most effective methods for preventing measles outbreak. It is necessary that all individuals who have not received vaccination against measles be vaccinated as soon as possible [10].

Serum immune globulin shots: Individuals who have been exposed to the virus should receive serum immune globulin shots to prevent development of measles.

Summary

Measles (rubeola, morbilli, english measles) is an acute, contagious viral disease caused by the measles virus, a single-stranded, negative-sense enveloped RNA virus of the Paramyxoviridae family.

Symptoms include fever, cough, conjunctivitis, coryza and a generalized, maculopapular, erythematous rash. Supportive care is normally all that is required for patients with measles.

This viral disease spreads easily from person to person contact making the condition widely prevalent amongst the immunecompromised population. Once developed, the condition can have deleterious effects on the immunity of the affected children. Though measles can strike the children, it is known to affect individuals of all age groups. In the past, the disease was a common occurrence. However, after the introduction of the measles vaccine in the year 1963, the prevalence decreased significantly [1].

Patient Information

Definition

Measles is a viral infection which is highly contagious in nature. According to reports published by the World Health Organization, there were 2.6 million deaths due to measles in the year 1980. With the introduction of measles vaccination, the death rate dropped dramatically, but there were still high cases of measles reported each year worldwide.

Cause

The disease is spread when individuals with weakened immune system come in contact with infected droplets of person with measles. When an infected person sneezes or coughs, the droplets can stay in active state for 2 hours and can cause infection in someone who comes in contact with it.

Symptoms

Measles primarily begins with development of rash which first appears on the head and later on spreads to rest of the body. Affected individuals also experience fever, cough, cold, muscle pain, sore throat, conjunctivitis, bloodshot eyes and sensitivity to light.

Diagnosis

Diagnosis of the condition is made on basis of careful examination of the rash. If along with the usual rash a bluish–white spots develops inside the mouth then the diagnosis of measles is confirmed.

Treatment

No specific treatment for measles exists. Affected individuals are vaccinated against the disease to decrease the severity of the symptoms. In addition, certain medications are given to manage the symptoms. Individuals who are exposed to the virus are given measles vaccination within 72 hours to prevent the onset of the disease.

References

Article

  1. Meissner HC, Strebel PM, Orenstein WA. Measles vaccines and the potential for worldwide eradication of measles. Pediatrics. 2004;114(4):1065-9.
  2. Griffin DE, Bellini WJ. Measles virus. In: Fields' Virology, Fields BN, Knipe DM, Howley PM (Eds), Lippincott-Raven, Philadelphia 1996. p.1267.
  3. Black FL. Measles. In: Viral infections in humans: Epidemiology and control, Evans AS, Kaslow RA (Eds), Plenum Publishing, New York 1997. p.507.
  4. Global measles mortality reduction and regional elimination: a status report. J Infect Dis 2003; 187(Suppl 1):S1.
  5. Coleman KP, Markey PG. Measles transmission in immunized and partially immunized air travellers.Epidemiol Infect. Jul 2010;138(7):1012-5.
  6. Measles. In: Red Book: 2012 Report of the Committee on Infectious Diseases, 29th ed, Pickering LK (Ed), American Academy of Pediatrics, Elk Grove Village, Illinois 2012. p.444
  7. Helfand RF, Heath JL, Anderson LJ, et al. Diagnosis of measles with an IgM capture EIA: the optimal timing of specimen collection after rash onset. J Infect Dis. Jan 1997;175(1):195-9.
  8. Barrabeig I, Rovira A, Rius C, et al. Effectiveness of measles vaccination for control of exposed children. Pediatr Infect Dis J 2011; 30:78.
  9. Centers for Disease Control (CDC). Measles prevention. MMWR Morb Mortal Wkly Rep 1989; 38 Suppl 9:1.
  10. Meissner HC, Strebel PM, Orenstein WA. Measles vaccines and the potential for worldwide eradication of measles. Pediatrics. 2004;114(4):1065-9.

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Last updated: 2017-08-09 18:15